Pharmacological management of sleep after traumatic brain injury

Driver, Sangeeta; Stork, Ryan

doi:10.3233/nre-182536

Cited by 15 publications

(3 citation statements)

References 30 publications

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“…One randomized controlled trial in adults comparing melatonin to amitriptyline found melatonin improved daytime alertness compared to controls, but no alterations in sleep latency or duration were observed [ 34 , 146 ]. Additionally, one RCT found a 4-week supplementation regimen to be safe and effective for improving sleep quality in patients with prior TBI [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Traumatic Brain Injury, Sleep, and Melatonin—Intrinsic Changes with Therapeutic Potential

et al. 2023

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Traumatic brain injury (TBI) is one of the most prevalent causes of morbidity in the United States and is associated with numerous chronic sequelae long after the point of injury. One of the most common long-term complaints in patients with TBI is sleep dysfunction. It is reported that alterations in melatonin follow TBI and may be linked with various sleep and circadian disorders directly (via cellular signaling) or indirectly (via free radicals and inflammatory signaling). Work over the past two decades has contributed to our understanding of the role of melatonin as a sleep regulator and neuroprotective anti-inflammatory agent. Although there is increasing interest in the treatment of insomnia following TBI, a lack of standardization and rigor in melatonin research has left behind a trail of non-generalizable data and ambiguous treatment recommendations. This narrative review describes the underlying biochemical properties of melatonin as they are relevant to TBI. We also discuss potential benefits and a path forward regarding the therapeutic management of TBI with melatonin treatment, including its role as a neuroprotectant, a somnogen, and a modulator of the circadian rhythm.

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Section: Discussionmentioning

confidence: 99%

Traumatic Brain Injury, Sleep, and Melatonin—Intrinsic Changes with Therapeutic Potential

et al. 2023

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“…Quetiapine may also be effective in managing aggressive behaviour [74], whilst propranolol, methylphenidate and valproic acid may also be helpful in managing agitation [72]. Benzodiazepines are not recommended due their negative effect on neurological recovery and high incidence of adverse effects [73].Trazodone is often used to manage insomnia, although there is little research in its use in patients with TBI [75].…”

Section: Rehabilitationmentioning

confidence: 99%

“…Benzodiazepines are not recommended due their negative effect on neurological recovery and high incidence of adverse effects [73]. Trazodone is often used to manage insomnia, although there is little research in its use in patients with TBI [75]. Tools such as the agitated behavioural scale can be used as a serial measure of changes in behaviours over time.…”

Section: Rehabilitationmentioning

confidence: 99%

Management of traumatic brain injury in the non‐neurosurgical intensive care unit: a narrative review of current evidence

et al. 2023

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Each year, approximately 70 million people suffer traumatic brain injury, which has a significant physical, psychosocial and economic impact for patients and their families. It is recommended in the UK that all patients with traumatic brain injury and a Glasgow coma scale ≤ 8 should be transferred to a neurosurgical centre. However, many patients, especially those in whom neurosurgery is not required, are not treated in, nor transferred to, a neurosurgical centre. This review aims to provide clinicians who work in non-neurosurgical centres with a summary of contemporary studies relevant to the critical care management of patients with traumatic brain injury. A targeted literature review was undertaken that included guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials (published in English between 1 January 2017 and 1 July 2022). Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also eligible for inclusion. Analysis of the topics identified during the review was then summarised. These included: fundamental critical care management approaches (including ventilation strategies, fluid management, seizure control and osmotherapy); use of processed electroencephalogram monitoring; non-invasive assessment of intracranial pressure; prognostication; and rehabilitation techniques. Through this process, we have formulated practical recommendations to guide clinical practice in non-specialist centres.

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